The Best Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Both OTC and prescribed NSAIDs help to reduce pain and swelling

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for treating a variety of common conditions, like arthritis, tendonitis, and bursitis. NSAIDs are useful because they help decrease pain, control swelling, and reduce inflammation.

However, anti-inflammatory medicines also come with some side effects, especially for people who have underlying risk factors. This article discusses the pros and cons of prescription and over-the-counter NSAIDs and alternatives to anti-inflammatory drugs.

What Does Anti-Inflammatory Mean?

Anti-inflammatory refers to the ability of a medicine to help fight pain and unwanted or abnormal immune system reactions by reducing inflammation.

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Prescription vs. OTC NSAIDs

NSAIDs are available in both over-the-counter (OTC) and prescription formulations. Some of the OTC anti-inflammatories are also available in stronger, prescription formulations. A class of NSAIDs called COX-2 inhibitors is available by prescription only.

While both OTC and prescription NSAIDs help relieve pain, prescription NSAIDs are more likely to reduce inflammation.

Many people experience adequate symptom relief with OTC NSAIDs and do not need to take stronger, prescription-strength options. Sometimes prescription NSAIDs are used because they provide longer-lasting relief. COX-2 inhibitors may be an option for people who have gastrointestinal side effects, which are common with OTC NSAIDs.

Which NSAID Is Best?

Usually, different NSAIDs can have similar effects. For example, if you are experiencing discomfort from arthritis, you might get relief from either Aleve (naproxen) or Advil (ibuprofen). But sometimes, people have a different response to treatment with a different medication, and a few medications might help your symptoms, while others do not have a significant effect.

It's difficult to predict which medications will be the most beneficial. The best way to determine which NSAID is best for you is to try different options. Often a healthcare provider will recommend one NSAID, and if symptoms don't improve within several weeks of treatment, another NSAID can be tried.

Keep in mind that you should not use more than one NSAID at a time unless your provider specifically tells you to combine them.

One of the best reasons to consider some of the COX-2 inhibitors, such as Celebrex or Mobic, is that these may be taken as once-a-day doses rather than three or four times daily. In addition, the COX-2 inhibitors are thought to have fewer side effects on the stomach.

Most Common NSAIDs

Healthcare professionals often use generic and brand names interchangeably, especially when recommending or prescribing NSAIDs.

The most commonly prescribed or recommended NSAID medications are:

Additional Treatment Options for Inflammation

Medicine isn't the only way to control inflammation and discomfort. Due to the possible side effects of medication, many patients and healthcare providers are interested in non-pharmacologic methods to control inflammation, especially chronic inflammation.

There are many ways to manage inflammation. Some have better scientific support than others, but almost all are safe to try.

A good place to start is with the R.I.C.E. treatment, which stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

Other treatments that may be helpful include certain foods and supplements, topical treatments, and physical activities.

An often-neglected method to control inflammation is rest. Getting enough overall rest and sleep, as well as taking it easy on the injured part of your body allows the inflammation to subside and the recovery process to unfold.

Not only does this mean resting from athletics, but often this means allowing an injured body part to rest from normal activities that may prolong inflammation. If you have a busy life, rest might not be built into your routine, but ignoring the signs of inflammation may prolong the problem.

Side Effects of NSAIDs

Side Effects of Nonsteroidal Anti-Inflammatory Medications

Verywell / Jessica Olah

NSAID medications have potential side effects, even those that can be obtained over-the-counter. Some of the side effects are minor, and others are potentially dangerous.

Some people may be more prone to side effects. However, it is important to understand that even for healthy people without underlying medical conditions, there is an associated risk. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

Anyone taking NSAID medications for more than a few days should have a discussion with their healthcare provider about the potential for side effects.

Some of the more common side effects of NSAID medications include:

  • Stomach upset/ulcers: Some people are prone to gastrointestinal upset and stomach ulcers as a result of taking these medications. People with a history of stomach ulcers need to use extreme caution with NSAIDs, and always under the supervision of their healthcare provider.
  • Hypertension/stroke: The use of NSAID medications, especially for routine, longer-term use, has been shown to increase the risk of hypertension and stroke.
  • Bleeding risk: Certain NSAID medications can cause an increased risk of bleeding. This is particularly true for aspirin. Most people can tolerate this, but people who have upcoming surgical procedures or are on other blood-thinning medications may not be able to take NSAID medication and will usually be advised to stop taking them for a specified amount of time prior to having the procedure.
  • Kidney problems: People with underlying kidney conditions may not be able to take NSAID medications, even in very low doses for a short time.
  • Heart disease: The COX-2 inhibitors have an FDA black box warning regarding an increased risk of heart attack. NSAIDs should not be used in the setting of prior heart disease, especially if you have had a coronary artery bypass graft (CABG).

These are not the only risks associated with NSAIDs, but they are the most common. It is always safest to have a discussion with your healthcare provider if you have any concerns about the risk of taking these medications.

A Word From Verywell

Nonsteroidal anti-inflammatory medications are commonly used for managing symptoms of musculoskeletal conditions. NSAIDs can be effective for a wide variety of conditions like arthritis, tendinitis, or other inflammatory conditions.

Determining the best anti-inflammatory drug for your condition may depend on a number of different factors, and what works well for one individual may not be the best medication for another. There are possible side effects of different NSAID medications you should be aware of, and you should check with your healthcare provider if you're taking these medications for more than a short period of time.

Frequently Asked Questions

  • Is ibuprofen or naproxen better for inflammation?

    There isn't much head-to-head research comparing the two. One older study found that both were effective for relieving the symptoms of knee arthritis, but naproxen helped with more symptoms, such as night pain. In general, ibuprofen takes effect and wears off more quickly, while naproxen has a slower onset but lasts longer.

  • Can I take ibuprofen and naproxen together?

    No. Ibuprofen and naproxen are both NSAIDs. Taking more than one NSAID at a time is not recommended because it can increase the risk of adverse effects like stomach issues and bleeding.

  • What is the strongest anti-inflammatory medication?

    Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available. Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex. It is also available as a topical gel, Voltaren, which is available over the counter.

  • What are the signs of inflammation?

    Inflammation is the body’s immune response to an injury or illness. Acute inflammation causes redness, swelling, heat, pain, and loss of function in the area that is inflamed.

  • How can I reduce inflammation quickly?

    Follow the RICE formula for managing inflammation due to an acute injury—rest, ice, compression, and elevation. For systemic inflammation, following an anti-inflammatory diet can help in the long term.

    NSAIDs and corticosteroids are often recommended for fast relief of pain and inflammation.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.